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GU and Renal Flashcards

1
Q

What is the epidemiology of renal stones (4)

A
  • 10-15% risk in lifetime
  • 50% re-occurrence rate
  • Most are calcium urate or calcium phosphate
  • More common in males, 20-40
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2
Q

What are the risk factors for renal stones (7)

A
  • Hypercalcaemia
  • Dehydration
  • Infection
  • Renal disease
  • Family history
  • Anatomical abnormalities
  • Gout
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3
Q

Describe the pathophysiology of renal stones

A
  • Stones formed in supersaturated urine
  • Most are calcium oxolate (60-65%), calcium phosphate (10%) or uric acid
  • Often can cause obstruction leading to hydronephrosis (blockage and dilatation of renal pelvis) which can lead to permanent damage
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4
Q

Where are the most common sites for renal stones to get stuck (3)

A
  • Pelvic brim
  • Pelvoureteric junction
  • Vesicoureteric junction
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5
Q

How might kidney stones present (4)

A
  • Renal colic
    • Sudden onset excruciating abdo pain
    • Patient writhing in pain, cannot lie still
    • Loin to groin in waves
    • Nausea and vomiting
  • Dysuria
  • Haematuria
  • Frequency
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6
Q

How would you diagnose renal stones (4)

A
  • Urine dipstick/midstream sample
  • KUB X-ray
  • Non-contrast CT KUB (gold standard/diagnostic)
  • Ultrasound
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7
Q

How would you treat renal stones (6)

A
  • Analgesia
  • Antibiotics if infection
  • Anti-emetics
  • Surgery
  • Lithotripsy
  • Medical expulsive therapy eg. Tamsulosin
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8
Q

Define acute kidney injury (AKI)

A
  • An abrupt sustained rise in serum Urea and Creatanine due to a rapid decline in GFR leading to inability to maintain acid base, fluid and electrolyte homeostasis
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9
Q

What is the criteria for AKI (3)

A
  • Rise in serum Cr >26umol/L in 48 hours
  • Rise in serum Cr >1.5x baseline
  • Urine output <0.5ml/kg/hour for 6+ hours
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10
Q

What is the epidemiology of AKI (2)

A
  • Common (occurs in 18% of hospital patients)

- Common in the elderly

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11
Q

What are the 3 causes of AKI

A
  • Pre-renal
  • Intra-renal
  • Post-renal
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12
Q

What are pre-renal causes of AKI (3)

A
  • Hypoperfusion
    • Hypotension/hypovolaemia
    • Dec. cardiac output
    • Shock
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13
Q

What are Intra-renal causes of AKI (4)

A
  • Nephrotoxic drugs
  • Vasculitis
  • Acute tubular necrosis
  • Glomerulonephritis
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14
Q

What are post-renal causes of AKI (3)

A
  • Blockage
    • Tumour
    • Stone
    • BPH
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15
Q

What are the risk factors for AKI (6)

A
  • Age >75
  • Heart failure
  • CKD/glomerulonephritis
  • Diabetes
  • Nephrotoxic drugs
  • Prostate cancer/BPH
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16
Q

How might AKI present (4)

A
  • Depends on cause
  • Oliguria
  • Oedema
  • Thirst
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17
Q

How would you diagnose AKI (2)

A
  • Using criteria

- Find underlying cause (biopsy, scans etc.)

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18
Q

What is the treatment for AKI

A
  • Treat underlying cause
  • Stop nephrotoxic drugs
  • Dialysis (hamofiltration/haemodialysis)
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19
Q

How can glomerulonephritis present (4)

A
  • Acute nephritic syndrome
  • Nephrotic syndrome
  • Asymptomatic urine abnormalities
  • Chronic kidney disease
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20
Q

What is acute nephritic syndrome characterised by (4)

A
  • Haematuria
  • Proteinuria
  • Oedema
  • Hypertension
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21
Q

What are the causes of acute nephritic syndrome (4)

A
  • IgA nephropathy (most common)
  • Infection/post infection
  • SLE
  • Systemic sclerosis
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22
Q

How might acute nephritic syndrome present (6)

A
  • Haematuria
  • Proteinuria
  • Oedema
  • Hypertension
  • Oliguria
  • Decreasing kidney function
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23
Q

How do you diagnose acute nephritic syndrome (3)

A
  • Mid stream urine/dipstick
  • Renal biopsy
  • Bloods (Raised Cr, Urea, Low albumin and eGFR)
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24
Q

How do you treat acute nephritic syndrome (2)

A
  • Treat cause

- Hypertension (CCB/diuretics)

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25
What are the characteristics of nephrotic syndrome (4)
- Proteinuria - Hypoalbuminaemia - Hyperlipidaemia - Oedema
26
What can cause nephrotic syndrome (2)
- Associated with podocyte damage - Minimal change disease (primary) - Diabetes (secondary)
27
How might nephrotic syndrome present (3)
- Proteinuria (frothy urine) - Oedema - May be hypertension
28
How do you diagnose nephrotic syndrome (3)
- Urine dipstick (proteinuria) - Bloods (hypoalbuminaemia, may be raised Cr/urea) - Renal biopsy
29
How do you treat nephrotic syndrome (4)
- Diuretics (oedema) - B.P control (proteinuria) (ACE-i) - Simvastatin (hyperlipidaemia) - Warfarin (low albumin can cause thrombosis)
30
What is chronic kidney disease (CKD) (2)
- A longstanding, usually progressive impairment of renal function for 3 months+ - Defined as GFR <60ml/min/1.73m2 for more than 3 months
31
What is the epidemiology of CKD (2)
- More common in females | - Inc. with age
32
What can cause CKD (9)
- Diabetes - AKI - SLE - Idiopathic - PKD - Atherosclerosis - Family history - Malignancy - Hypercalcaemia
33
Describe the pathophysiology of CKD
- Progressive scarring of nephrons leads to their failure - This means that the flow of blood is re-directed to other nephrons - This causes and increased flow and stress on the nephrons accelerating their scarring and failure
34
How might CKD present (7)
- Early stages are asymptomatic (kidney has large reserve volume - Malaise - Weight loss/anorexia - Polyuria/nocturia - Oedema - Nausea/vomiting/diarrhoea - Itching - Amenorrhea/E.D
35
How would you diagnose CKD (4)
- Urine sample - Renal biopsy - Ultrasound (small kidneys) - Bloods (raised Cr and Urea, Low eGFR and Ca)
36
How do you treat CKD (5)
- Control progression/complications - B.P control - Biphosphonates/Calcitriol (low calcium) - Simvastatin and warfarin (CVD) - Duiretics (oedema) - RRT - Transplant
37
What are the indications for dialysis in CKD/AKI (4)
- Hyperkalaemia - Symptomatic uricaemia - Pulmonary oedema - Acidosis
38
What are the 3 types of Renal replacement therapy (RRT)
- Haemofiltration - Haemodialysis - Peritoneal dialysis
39
Describe Haemofiltration
- Blood drawn through double lumen catheter by pump and replacement solution is infused in.
40
Describe Haemodialysis
- Blood drawn out through A.V fistula passed over semi-permeable membrane with solution passing other way allowing solutes to move down conc. gradient
41
Describe Peritoneal dialysis
- Peritoneum used a membrane for solute exchange with blood
42
What are the potential complications of RRT (3)
- Hypertension (stroke/MI) - Malignancy - Infection
43
Describe the epidemiology of autosomal dominant polycystic kidney disease (ADPKD) (3)
- Most common inherited kidney disease - More common in males - Presents in early adulthood
44
What mutations occur in ADPKD and ARPKD (3)
- PKD 1 on chromosome 16 - PKD 2 on chromosome 4 - PKHD 1 on chromosome 6 (ARPKD)
45
Describe the pathophysiology of PKD
- Cysts cause mechanical pressure and reactive fibrosis leading to progressive renal failure - The rate of renal decline depends on the size and growth rate of cysts
46
How might PKD present (5)
- Haematuria - Loin pain - Palpable enlarged kidney - Nocturia - Stones
47
How would you diagnose (AD/AR) PKD (2)
- Ultrasound - Enlarged cystic kidneys - 15-39 (3) - 40-59 (2 on each) - 60+ (4 on each) - Family history/genetic testing
48
How do you treat PKD (4)
- B.P control - Laproscopic removal/nephrectomy - Family screening - RRT for ESRF
49
How do you tell different diseases by testicular palpitation (5)
- Can't get above it = Hernia or hydrocele - Separate and cystic = epididymal cyst - Separate and hard = varicocele - Testicular and cystic = hydrocele - Testicular and hard = tumour
50
What is the epidemiology of epididymal cyst (3)
- Cyst containing milky fluid - Not uncommon - Most common about 40
51
How might epididymal cysts present (4)
- Usually have noticed a lump - May be multiple and bilateral - Symptomatic if large - Palpable separate from testis and cystic
52
How do you diagnose and treat epididymal cysts
- Testicular ultrasound | - Surgery if symptomatic
53
What is the Epidemiology of hydrocele (2)
- Abnormal collection of fluid in tunica vaginalis | - Can be primary or secondary
54
How might hydrocele present (2)
- Non tender, smooth swelling of testicles | - Only painful if infected
55
How do you diagnose/treat hydrocele
- Testicular ultrasound | - Needle aspiration or surgery if symptomatic
56
What is the epidemiology of varicocele (3)
- Abnormal swelling of testicular veins due to venous reflux - Incidence increases after puberty - More common on the left side
57
How might varicocele present (3)
- 'Bag of worms' - Hard and separate - Dull ache and heavy scrotum
58
How do you diagnose/treat varicocele
- Venography | - Surgery is symptomatic
59
What is the epidemiology of testicular torsion (2)
- Twisting (torsion) of spermatic cord leading to vessel occlusion and hence ischaemia and infarct - Left side is more commonly affected
60
How might testicular torsion present (4)
- Sudden onset severe testicular pain - Abdominal pain - Nausea and vomiting - Very hot, swollen, tender testicle
61
How do you diagnose testicular torsion
- DO NOT DELAY SURGERY | - Doppler ultrasound
62
What is the treatment for testicular torsion
- Rapid surgery (6 hours to save testicle) | - Orchidectomy
63
What are the storage LUTS (4)
- Overflow incontinence - Urgency - Frequency - Nocturia
64
What are the voiding LUTS (7)
- Haematuria - Dysuria - Hesitancy - Poor stream - Post micturition dribbling - Poor emptying - Straining
65
What is acute urinary retention and how might it present
- A painful inability to pass urine, usually with over 500ml urine in the bladder - Cannot pass urine, painful/tender palpable bladder
66
What can cause acute urinary retention (6)
- LUT obstruction (stones/tumour) - BPH/Prostate cancer - Cauda equina syndrome - Alcohol - Post op - Infection
67
How do you treat acute urinary retention (4)
- Catheterise - Tamsulosin (alpha 1 blocker) - Finasteride (5 alpha reductase inhhibitor) - Treat underlying cause
68
What is the epidemiology of benign prostate hyperplasia (BPH) (3)
- Inc. with age - Common (40% of over 60) - Afro-Caribbeans more affected
69
How might BPH present
- Nocturia (most common) | - Typical LUTS
70
How do you diagnose BPH (4)
- DRE (smooth, enlarged prostate) - Serum PSA raised - Ultrasound - Urine dipstick/midstream to exclude infection
71
How do you treat BPH (3)
- Alpha 1 antagonists (tamsulosin) - 5 alpha reductase inhibitors (finasteride) - Surgery (transurethral resection of prostate)
72
What is the epidemiology of renal cell carcinoma (RCC) (3)
- Most common renla tumour in adults - Rare under 40 - More common in males
73
What are the risk factors for RCC (6)
- Smoking - Obesity - Hypertension - PKD - Von Hippel Lindau syndrome - Renal replacement therapy
74
Describe the pathophysiology of RCC
- Malignancy of the proximal convuluted tubule epithelium | - 25% metastases on presentation
75
How might RCC present (5)
- Haematuria - Loin/flank pain - Palpable mass - Anorexia, weight loss, malaise - Hypertension (some RCC secrete renin)
76
How do you diagnose RCC (3)
- Renal biopsy - Ultrasound - MRI (staging)
77
How do you treat RCC (3)
- Total/partial nephrectomy - Chemotherapy - Radiotherapy
78
What is the epidemiology of transitional cell carcinoma (TCC) (3)
- 50% bladder - 4th most common cancer in men, 8th in women - More common in older people
79
What are the risk factors for TCC (6)
- Male - Smoking - Rubber/chemical industry - Inc. age - Catheter - Family history
80
How might TCC present (2)
- Painless haematuria | - Voiding irritability
81
How do you diagnose TCC (3)
- Cystoscopy (diagnostic) - CT/MRI - Urine dipstick/mid-stream sample
82
How do you treat TCC (4)
- Resection of tumour - Radical cystectomy - Radical radiotherapy - Chemotherapy
83
What is the epidemiology of prostate cancer (5)
- 4th most common cancer in men - Increases with age - By 80, 80% of men have a malignancy, but most are inactive - Mostly adenocarcinoma in peripheral zone of prostate - More common in black people due to raised testosterone
84
What are the risk factors for prostate cancer (4)
- Increasing age - Black - Family history - Genetic
85
How might prostate cancer present (3)
- Nocturia - LUTS - Malaise, weight loss, anorexia
86
How do you diagnose prostate cancer (3)
- Trans-rectal ultrasound with biopsy - DRE (hard, irregular) - Serum PSA
87
How do you treat prostate cancer (3)
- Often just monitoring - Endocrine therapy - Androgen receptor blockers (bicalutamide) - Radiotherapy
88
What is the epidemiology of testicular cancer (3)
- Most common cancer in men aged 15-44 - 10% occur in undescended testis - >96% arise from germ cells
89
What are the risk factors for testicular cancer (3)
- Family history - Undescended testis - Infertility
90
How might testicular cancer present (4)
- Hard lump in testicle (may be painless) - Testicular (w/without abdominal) pain - Hydrocele - Weight loss/malaise
91
How do you diagnose testicular cancer (3)
- Testicular ultrasound - Biopsy - CT (staging)
92
How do you treat testicular cancer (4)
- Orchidectomy - Radiotherapy - Chemotherpay - Sperm storage
93
Define UTI (2)
- Inflammation of urothelium in response to bacterial colonisation - 10^5 organisms/ml in fresh mid-stream urine sample
94
What 5 pathogens usually cause UTI
- KEEPS - Klebsiella spp - E.coli (most common) - Enterococci - Proteus spp - Staphylococcus spp
95
What is the epidemiology of pyelonephritis (2)
- More common in women <35 | - Associated with significant sepsis
96
What are the risk factors for pyelonephritis (6)
- Structural abnormality - Stones - Catheter - Pregnancy - Diabetes - Immunosupression
97
How might pyelonephritis present (5)
- TRIAD: loin pain, fever, pyuria - Severe headache - Oliguria - Rigors/malaise - Nausea and vomiting
98
How do you diagnose pyelonephritis (2)
- Urine dipstick | - Mid stream urine microscopy
99
How do you treat pyelonephritis
- Rest, water, cranberry juice - Analgesia - IV/oral co amoxiclav
100
What are the risk factors for cystitis (4)
- Catheter - Stones/obstruction - Previous bladder damage - Incomplete bladder emptying
101
How might cystitis present (2)
- LUTS | - Abdo./loin pain/tenderness
102
How do you diagnose cystitis (2)
- Urine dipstick | - Mid stream urine microscopy
103
How do you treat cystitis
- Trimethoprim | - Co amoxiclav if severe/non-responsive
104
How might prostatitis present (4)
- Voiding LUTS - Pelvic pain - Fever, rigors, malaise - Pain on ejaculation
105
How do you diagnose prostatitis (4)
- Mid-stream urine sample - Urine dipstick - DRE (warm, swollen and tender) - Trans-urethral ultrasound
106
How do you treat prostatitis (2)
- Acute - IV co amoxiclav and gentamicin - Chronic - Ciprafloxacin
107
What is the epidemiology of urethritis (2)
- Primarily caused by STI (chlamydia most common and gonorrhoea) - Most common urological condition in men
108
How might urethritis present (4)
- Dysuria +/- blood and pus - Urethral pain - Penile discomfort - Systemic symptoms
109
How do you diagnose urethritis (2)
- First void urine in men, vaginal swab in women (microscopy) - Urethral swab
110
How do you treat Urethritis (2)
- Chlamydia (azithromycin) | - Gonorrhoea (azithromycin and ceftriaxone)
111
What is the aetiology of epididymo-orchitis (4)
- <35 STI - >35 UTI - Mumps - Catheter
112
How might epididymo-orchitis present (3)
- Unilateral swollen and painful testis - Sweats/fever - May be dysuria
113
How do you diagnose Epididymo-orchitis (2)
- First void urine microscopy | - Urethral swab/smear
114
How do you treat epididymo-orchitis
- Chlamydia (azithromycin) - Gonorrhoea (azithromycin and im ceftriaxone) - UTI (ciprofloxacin)

Finals (11 decks)

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